The Shoulder Joint Problems

Q: What is the importance of the shoulder joint in our body?

A: Shoulder is one of the most mobile joints of our body. It has a very very important role in our life – to place our hands in positions where they can be useful. Imagine, if your shoulder is painful, you will not be able to take your hand to your mouth to feed yourself, or you won’t be able to take your hand to your back for cleanliness.

 Q: Does shoulder joint get affected by any problem or disease process?

A: The shoulder joint is as vulnerable to various problems as any other joint in the body. But, usually the patients present to the doctor very late as it is a non-weight bearing joint; hence most patients carry on suffering for a long time.

 Q: What are the various problems which can affect the shoulder joint?

A: Other than fractures and acute joint dislocations, shoulder can be affected by many problems. For the sake of simplicity, I have divided the various shoulder problems into three categories based on the age of the patient:

1. Young age (upto 30 years): Recurrent shoulder dislocation, biceps tendonitis, SLAP tear.
2. Middle age (30 – 50 years): Shoulder impingement, Frozen shoulder, Calcific Tendonitis
3. Old age (50 years onwards): Rotator cuff tear, Osteoarthritis

Q: What are the common symptoms of the shoulder problem?

A: The most common shoulder symptoms are – pain (usually worse at night and on doing overhead activities), decreased range of movements (especially internal rotation i.e difficulty to take your hand to your back & over your head), or clicking sounds in the shoulder joint.

 Q: Starting with the young, what are the common shoulder problems? How can these be managed?

A: The most common shoulder problem in youngsters is called recurrent shoulder dislocations, i.e., their joint keeps popping out again and again. It usually starts after a significant injury, but with the passage of time, the joint comes out with even trivial activities like putting your shirt on. This problem is usually easily treatable by surgery, either through arthroscopy (keyhole) or open surgery. The other common problem is the tendonitis of the biceps tendon – where the tendon of the biceps becomes inflamed and swollen. This is treated by rest, physiotherapy and cortisone injection. If it does not improve with these, then a keyhole surgery will get rid of the symptoms. Sometimes, the tendon of the biceps peels off from its bed, called SLAP Tear. This needs surgery to fix it back to its bed.

 Q: Now coming to middle age, please tell us about the common problems of the shoulder and their management.

A: Between the ages of 30 years and 50 years, most shoulder problems will be either shoulder impingement, Frozen shoulder, and/or Calcific Tendonitis. Shoulder impingement is a condition in which the top bone of the shoulder starts rubbing against the outer bone of the shoulder. As a result, the muscle of the shoulder starts getting caught between the two bones and becomes painful. This can be treated by physiotherapy, cortisone injection and arthroscopic surgery, wherein, we shave off the bone which is rubbing and causing the problem. Now, talking about the most talked about disease in the shoulder – Frozen shoulder!! Frozen shoulder is a condition in which the lining of the shoulder joint becomes inflamed and sticks to the bones of the joint, thereby making the joint extremely painful and all movements become restricted and painful. It is most commonly seen around 50 years of age, more common in ladies, diabetic and those with thyroid problems. It is treated by physiotherapy, injections, and if these don’t help, then arthroscopy. Important note here is that Frozen shoulder usually is responsible for only 10% of all the shoulder problems. In 90% of the patients, the diagnosis will be something else, but they will be wrongly labelled as frozen shoulder and wrongly treated, without much benefit. Lastly, Calcific Tendonitis is a condition in which there is calcium deposit in the muscles of the shoulder, and like Frozen shoulder, it is very very painful. It is treated either by injections under X-Ray or by arthroscopic surgery.

 Q: Finally, the problems of the old shoulders?

A: The most common problem in shoulders after the age of fifty, is a tear in one of the tendons of the shoulder muscles. It is an age related phenomenon, and the chances of having a rotator cuff tear increases with age. While at the age of 60 years, almost 15-20% people will have a rotator cuff tear, by the age of 70 years, almost 30-40% people will have it. So, the chances of your having a rotator cuff tear with age are same or more than your chances of getting knee osteoarthritis. The most common symptoms are pain and decreased range of movements. If symptomatic, then we first try painkillers, physiotherapy and exercises. I usually do not prefer to give cortisone injections in cases of rotator cuff tears, unless there is no other option. If patients do not improve with these measures, then they will need repair of the torn tendons, which can be done arthroscopically, with very good results. Finally, comes the osteoarthritis of the shoulder joint, which is less common than the osteoarthritis of the knee, and is managed by replacing the shoulder joint, just as in the case of knee replacement.

 Q: Please tell us more about the arthroscopy (keyhole) surgery of the shoulder.

A: Arthroscopy or keyhole surgery of the shoulder is a relatively new branch of orthopaedics. It started in the western countries in late 1980s and became more popular in 21st century. The results have improved dramatically in last 10-15 years with more than million of arthroscopies being performed all over the world every year. The surgery is performed by making 2-4 tiny holes around the shoulder joint and inserting a camera and instruments through these holes to do the necessary repair work. The advantages of this surgery are that it gives a very magnified and very well-lit view of the problem inside the shoulder, hence, improving the quality of the repair. Also, using only tiny holes makes the postoperative recovery much faster and less painful. In India, it is still a very new branch with very few surgeons trained and capable of doing the arthroscopy of the shoulder joint.

 Q: What is the success rate of shoulder surgeries?

A: In the hands of shoulder specialists, the results of shoulder surgery are very good. The results of shoulder surgery world over have reached close to 90-95% success mark. The only problem is that not every orthopaedic surgeon is trained to deliver these high results. Hence, it is better to go to a trained shoulder specialist to get good results.